This
is the first entry in a series of blogs that I will randomly put out whenever I
feel there is a random topic that deserves mention but isn’t big enough for a
full article of its own.
Over
the last week an article questioning the biopsychosocial (BPS) model (https://www.regenexx.com/confounding-biopsychsocial-model/)
has made waves in the physical therapy & rehab worlds. I’m not the type to
slam anyone or call anyone out on social media – that’s not my style. However
the article, and recent research on pain, warrants some discussion and points.
1) In the
health & fitness industry we, to quote Results Fitness owner Alwyn Cosgrove
(http://alwyncosgrove.com/) “overreact
in the short term and underreact in the long run.” Initially we thought every
single postural, structural, or biomechanical abnormality was causing our
patients pain…and in recent years we sometimes tend to brush off imaging
findings and not worry so much about posture or movement.
In
reality a healthy mix is indicated as many “abnormal” MRI findings are common
in painfree people but can also be linked with pain in some situations. Same
idea with postures & movements. Read my brilliant colleague Ben Cormack’s
article on the topic here (https://cor-kinetic.com/quit-arguing-matters-just-not-everybody/).
It shows the importance of clinical reasoning in determining what’s relevant to
the individual.
We
as humans like simple answers. I’d love to think that biomechanics (or
psychosocial factors) are or aren’t relevant to everyone – but it doesn’t work
that way.
2) It is
important to educate people about the strong, adaptive nature of the body. I
don’t doubt that. At the same time we also have to be realistic about the body’s
capacity to adapt and bear load. For instance, while the SI joint is strong and
stable as hell it isn’t bombproof. Just saying.
3) The
article made a good point that bears mentioning. While we have a large body of
research (see my previous articles for references) saying that psychosocial
factors can be risk factors for pain – I do believe pain and injury can cause
anxiety, stress, fear of movement etc. Some research (again cited in the
original article) showed that eliminating (or reducing) pain can alleviate the
psychosocial factors.
While some may disagree with
me I also anecdotally believe that certain injuries can be great sources of
anxiety, fear and depression as well. Take for instance someone who easily
dislocates their shoulder or knee … or someone with a history of recurrent
ankle sprains … or someone who easily fractures due to osteoporosis.
The
big takeaway from this is that it all matters – just in varying amounts to each
individual.
On
Monday I will release my next article which discusses the topic of CrossFit. As
I promised I would have some content geared towards the meatheads, lifters,
trainers, and strength coaches out there and I figured its time to take a short
break from all the physical therapy content.
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